RU2201147C2 - Method for suturing perforated opening in a hollow organ - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves suturing the perforated opening with autoplastic material used as tampon. The following operations are done in succession. Hollow organ wall is pierced inside from outside, autoplastic material is pierced with single ordinary loop suture being created and the hollow organ wall is pierced outside from inside. The autoplastic material is pulled towards the perforated opening. The opening edges are brought close to each other and fixed filling holes to hollow organ wall thickness. Piercing the hollow organ is carried out somewhere apart from the perforated opening edges along the longitudinal axis of the hollow organ. EFFECT: simplified method; improved sealing properties of applied suture. 1 dwg

Description

 The invention relates to medicine, in particular to the treatment of perforated ulcers of the stomach and duodenum.

 Currently, the main treatment for perforated ulcers is surgery. More than 30 methods for treating perforated ulcers are known. Of these, perforation hole suturing, primary resection of the stomach, vagotomy with perforated ulcer excision and pyroplasty, and selective proximal vagotomy with perforated hole suturing (A.A.Shalimov, V.F.Saenko. Digestive surgery. Kiev: Zdorova, 1987, p. 567) - [1].

 Many methods are known for suturing perforated gastric and duodenal ulcers. For the first time, suturing of perforated ulcers Miculicz and Heussner was performed, and in Russia - R.Kh. Vanah. When suturing perforated holes, various sutures are used: purse-string, mattress, single-row, chained and others - [1, Part II, Surgery of the stomach and duodenum, p. 153-374].

 With simple suturing, the edges of the hole are punctured with a needle and thread and pulled together, thus performing several seams. Since the edges of the perforated holes are infiltrated, when such joints are applied, they erupt, which creates the conditions for the formation of insolvency of the joints and the development of peritonitis.

 Known methods for suturing perforated holes using various additions in the form of an autoplastic material: walls of adjacent organs, omentum, round ligament of the liver, which cover the holes with subsequent suturing of its edges: tamponade with muscles, followed by suturing according to V.A. Krasintsev; suturing with plastic with an insulated gland according to S.M. Malinovsky; suturing with a single-row suture with an omentum according to D.M. Dolgat; plastic by serous-muscular flap of the stomach wall - L.V. Serebryannikov and V.P. Snezhkova; plastic with an isolated omentum and muscles - Yu.Kh. Petrova; plastic with an isolated omentum and parietal peritoneum - N.A. Kulichkov and other methods - [1, p.228-232].

 However, an isolated omentum or other biological tissue, lacking nutrition, lengthens the healing time of the suture and can cause inflammatory processes.

 Known methods for suturing perforations of hollow organs using an autoplastic material on the feeding leg: hemming an omentum with additional tamponade with gauze - V.A. Oppel; suturing with a mattress seam with plastic omentum - M.A. Kantorovich; plastic reinforced gland - A.B.Savchik [1, p. 231-232]. I.I. Neymark, when suturing the edges of the perforation hole, fixes the gland on the leg to the seam line. A.A.Shalimov and V.F.Saenko bring the edges of the perforated hole together (without screwing). then, with 2-3 sutures, impose a second row of serous-muscular sutures and hem around the omentum on the feeding leg. This approach can lead to narrowing of the pyloroduodenal canal. In addition, the imposition of these sutures is quite laborious with the laporoscopic method of suturing the perforated hole.

 For comparative analysis with the claimed method of suturing perforated holes of hollow organs, the method of suturing according to P.N. Polikarpov - suturing with tamponade with an omentum on a leg [1, p.231-232]. According to this method, a lock of omentum on a leg is brought to the perforated hole using a ligature, two threads of which suture the wall of the stomach or duodenum from only one side of the perforated hole from the inside out. Then the ends of the ligature are tied, fixing this lock of the stuffing box in the perforated hole.

 However, the perforated hole sewn in this way has insufficient tightness.

 The invention solves the problem of simplifying the process of suturing a perforated hole while achieving high tightness of the seam.

 The problem is achieved in that by the method of suturing the perforated hole of a hollow organ with the tamponade of the perforated hole with an autoplastic material on the supply leg, sequentially using one needle and thread, the walls of the hollow organ are pierced “from outside to inside”, the autoplastic material is pierced and the wall is pierced from “inside to outside” pulling the ends of the thread of the autoplastic material to the perforated hole, which closes the latter, filling it to the wall thickness of the hollow organ, the edges of which vyazyvaniem filaments converge and are fixed in this position, forming a single loop seam is sealed up, wherein the piercing hollow organ walls is performed with a deviation from the edges of the perforation holes and along the longitudinal axis of the hollow body.

 The invention is illustrated in the drawing, which shows the closure of the proposed method.

 Here: 1, 2 - the edges of the perforated hole; 3 - a hollow organ; 4 - autoplastic material on the supply leg (lock of stuffing box on the leg); 5 - ligature.

 The Malkov method is as follows.

 Departing from the edge of the perforation hole by ~ (5-8) mm, the wall 2 of the hollow organ 3 is punctured with a thread 5 “from the outside to the inside of the hollow organ” along the longitudinal axis of this organ. The needle with thread 5 is removed from the perforated hole, leaving the end of the thread outside the hollow organ 3, and a lock of the stuffing box on the leg 4 is stitched, for example, with a loop seam. Then, with the same needle and thread, also departing from the edge of the perforated hole by ~ (5-8) mm, pierce the opposite wall 1 of the hollow organ 3 "from the inside of the hollow organ to the outside" along the longitudinal axis of the hollow organ. Then, the locks of the stuffing box 4 are pulled by the ends of the thread that are on both edges of the perforated hole, which rests on the hole, closing it, and the ends of the thread are tied over the stuffing box without tension, and the edges of the perforated hole come closer together. As a result, the perforated hole turned out to be sealed as a single looped filling seam (PPSh).

 Thus, the proposed method for suturing the perforation of the stomach and duodenum is simple in technical design, does not narrow the pyloroduodenal canal, and provides the necessary tightness of the sutured defect, which allows it to be used along with the traditional method (laparotomy) and with the endosurgical treatment of perforated ulcers.

Claims (1)

 A method of suturing a perforated hole in a hollow organ with tamponade of the perforated hole with an autoplastic material on the supply leg, characterized in that the walls of the hollow organ are pierced externally with one needle and thread, then the autoplastic material is flashed to form a single loop stitch, the hollow organ wall is pierced “from the inside out”, the autoplastic material is pulled by the ends of the thread to the perforated hole, closing the latter with the autoplastic material, the edges of the hole are brought together and fixed in this position, the thickness of the hole plombiruya hollow organ wall, the piercing hollow organ walls is performed with a deviation from the edges of the perforation holes and along the longitudinal axis of the hollow body.